Abstract Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy and is frequently identified incidentally on imaging. Emerging evidence suggests a potential association between inflammatory bowel disease, particularly Crohn's disease, and an increased risk of extraintestinal malignancies, including thyroid cancer; however, this relationship remains incompletely understood and largely observational. We report the case of a 21-year-old male with a history of Crohn's disease, maintained on long-term azathioprine therapy, who presented with anterior neck discomfort and was found to have a highly suspicious thyroid nodule on ultrasound (American College of Radiology Thyroid Imaging Reporting and Data System ACR TI-RADS 5). Fine needle aspiration cytology confirmed PTC, with metastatic involvement of a cervical lymph node demonstrated by cytology and markedly elevated thyroglobulin washout. The patient underwent total thyroidectomy with central compartment and right neck dissection, with final histopathology confirming papillary thyroid microcarcinoma with nodal metastasis (pT1a, pN1a). He subsequently received radioactive iodine therapy with an excellent biochemical and structural response on follow-up. This case highlights a potential relationship between chronic inflammatory disease, immune dysregulation, and malignancy risk. While an association between Crohn's disease and thyroid cancer has been reported, causality cannot be established. Further studies are required to better define the underlying mechanisms and to identify patients who may benefit from targeted surveillance strategies.
Farooqui et al. (Tue,) studied this question.
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